University of Helsinki, FIN-00014 University of Helsinki, Finland.
Patient Educ Couns. 2010 Feb;78(2):218-23. doi: 10.1016/j.pec.2009.07.011. Epub 2009 Sep 19.
Tolerance of uncertainty related to the complex work is a major dimension of general practitioner's (GP) profession. Strategies for managing uncertainty have been studied among GPs but less is known about how medical students develop tolerance of uncertainty during their studies. The aim of this study was to investigate how the medical students experience uncertainty during their first clinical years and how their feelings develop with time as they progress from the 3rd year to the 4th year.
The material consisted of 22 students' reflective learning diaries and writings on specific themes collected during the 3rd and 4th year of their medical studies. The analysis was performed using thematic content analysis. In this article we present the results related to the theme of uncertainty.
Uncertainty is a major cause of mental strain for medical students, particularly fear of making mistakes. Main themes related to facing uncertainty and found in the diaries and writings were insecurity of professional skills, own credibility, facing with the inexactness of medicine, fear of making mistakes, coping with responsibility, and tolerating oneself as incomplete and accepting oneself as a good-enough doctor-to-be. Common steps of development towards tolerance of uncertainty were found in diaries over a one-year time period as the students progressed in their clinical studies.
Reflective writing showed to be an effective means for the students of both expressing and dealing with uncertainty, both with the difficult and the pleasant feelings and the experiences the students had with their first patient contacts. It also gave some of them the means of self-reflection which they afterwards found worthwhile.
Reflective writing is powerful tool which medical students could use to facilitate their maturation process what comes to uncertainty during their first clinical year.
与复杂工作相关的不确定性容忍度是全科医生（GP）职业的一个主要维度。已经研究了全科医生管理不确定性的策略，但对于医学生在学习期间如何发展不确定性容忍度知之甚少。本研究旨在调查医学生在第一临床年期间如何体验不确定性，以及随着他们从第 3 年到第 4 年的进步，他们的感受如何随着时间的推移而发展。
材料包括 22 名学生的反思性学习日记和在第 3 年和第 4 年医学学习期间收集的特定主题的写作。分析使用主题内容分析进行。在本文中，我们介绍了与不确定性主题相关的结果。
不确定性是医学生精神压力的主要原因，尤其是害怕犯错。在日记和文章中发现的与面对不确定性相关的主要主题包括专业技能的不安全感、自身可信度、面对医学的不准确性、害怕犯错、承担责任以及容忍自己不完美并接受自己是一名足够好的准医生。在学生临床学习期间，通过一年的时间，在日记中发现了朝着不确定性容忍度发展的常见步骤。
反思性写作被证明是学生表达和处理不确定性的有效手段，包括困难和愉快的感觉以及学生与他们的第一个患者接触的经历。它还为他们中的一些人提供了自我反思的手段，他们后来发现这是值得的。
反思性写作是医学生在第一临床年期间促进不确定性成熟过程的有力工具。
